[Objective]To investigate effects of surgical treaments applying different fixation apparatus and bone inducing material on atlanto-axial unstableness.[Method]Twenty-four cases of Afianto-axial unstablmaess were treated by posterior internal fixatiun and bono grafting,19 cases were operatad with Apofix instrument system and 5 cases with AOSYS instrument system,bone grafting was used with artificial bone inducing material.The fusion rate,physical curve of cervical vertibrae and side-effect of implantation were observed and function were evaluated.[Result]The follow-up period was from 6 months to 36 months.The average was 18 months.Bony implanting side-effect was not found.Pre-operative symptoms of nervours systems disappeared in 18 cases,diminished in 5 cases,improved in 1 case after operation.Function evaluation:excellent 20 casas,good 2 cases,better 2 casas,excellent rate 92.4%.[Conclusion]Authors consider that odontoid fracture with atlantoaxial unstabilization can be treated by surgical operation of posterion fusion appling Apofix,AOSYS systems with osteoinduction active materials to obtain instant stabilization and permanent arthrodesis,which is an effective method to re-establish the stableness of upper cervicals.

[Objective]To evaluate the surgical effect of posterior correction and instrumentation on the treatment of congenital kyphoscolosis deformity. [Methods]From july 2002 to august 2007,there were 15 congenital kyphoscoliotic patients,which included 8 males and 7 females with an average age of 11.6 years.The average Cobb’s angle of scoliosis was 78?(35?~156?),the average Cobb’s angle of kyphosis was 25?(15?~38?).For the 9 kyphoscolsis patients with hemivertebra,hemivertebra resection and intervertebral fusion and fixation with pedicle screw instrument system were used,Luque’s systems was used in 2 cases,for the 3 cases accompanied with Chiari malformation and/or syringomyelia and 1 case with neurofibroma,posterior correction and long segmental pedicle screw fixation were performed and the compensative curve was included in the instrumentation level.[Results]The operation time was 3.5~7.5 h (average,5.5 h ),the blood loss was 300~2 100 ml (mean,850 ml);the average follow-up was 43 months (10~82 months),and the radiographs taken from standing posteroanterior position and lateral side showed that the mean Cobb’s angle of scoliosis was corrected from preoperative 78? to postoperative 28?(11?~38?),with a correction rate of 64%.Postoperatively ,the angle of kyphosis was improved from the preoperative 25? to 16?( 7?~33?),with a correction rate of 36%.Solid fusion was achieved in all 15 cases of patients. But significant blood loss occurred in the operative procedure of neurofibroma. And long term follow-up showed 3 cases of rod fracture,1 case of crankshaft phenomenon.[Conclusion]The congenital kyphoscolosis deformity is a kind of complex syndrome concerning skeleton-muscle-nerve system,aim to different cause,strategy of treatment should be individualized.The posterior hemivertebral resection and correction is a safe and effective method for the prepubertal children with the congenital hemivertebrae deformity.

Objective To evaluate the effect of preoperative oral finasteride on patients with benign prostate hyperplasia (BPH) undergoing holmium lasterenucleation of prostate (HoLEP).Methods A total of 156 BPH patients from Department of Urology in Shanghai Ninth People's Hospital from Sep.2010 to Mar.2012 was analyzed retrospectively.79 patients receiving oral 5 mg/d finasteride before operation were selected as medication group,and the 77 patients without taking finasteride were selected as control group.The perioperative data,including operation time,amount of washing fluid during operation,preoperative and postoperative changes of hemoglobin level and postoperative bladder washing time were compared between two groups.Results Compared with control group,the changes of hemoglobin level after HoLEP,amount of washing fluid during operation,and postoperative bladder washing time with normal saline were significantly decreased in experimental group[(1.08±0.27) g/L vs.(1.55±0.32) g/L,(27.51±3.67) L vs.(36.89±6.47) L,(24.85±4.17) h vs.(35.87±5.10) h,all P＜0.05].Conclusions Oral finasteride before HoLEP can reduce perioperative bleeding and the volume of bladder irrigation with normal saline.

?AlM: To analyze the result of ultrasound biomicroscopy ( UBM ) of patients with rhegmatogenous retinal detachment ( RRD ) who need to perform pars plana vitrectomy ( PPV ) to explore the value of clinical application of UBM at preoperation.
?METHODS:Patients who underwent PPV for RRD in our hospital from January to December 2014 were selected. The preoperative results of UBM were recorded and the positive findings of UBM were analyzed, the value of preoperative application of UBM was investigated.
?RESULTS:Totally 356 cases (357 eyes) of patients with RRD were received PPV. All patients were examined by UBM, 122 eyes ( 34. 17%) were positive, 56 eyes were ciliochoroidal detachment, 28 eyes were narrow anterior chamber angle, 6 eyes were chamber angle-closure, 28 eyes were ciliary body cyst, 4 eyes were iris cyst, 11 eyes were anterior proliferative vitreoretinopathy, 1 eye was retinal cyst. There were 12 eyes existing two lesions at the same times. ln this study, patients with choroidal detachment was detected by UBM in 56 eyes, the positive rate was 15. 7%, while 25 eyes was detected by B -ultrasonography, the positive was 7. 0%. The difference was statistical significant(χ2=13. 382, P<0. 05).
?CONCLUSlON: The patients with RRD have underwent PPV for the condition of illness, preoperative UBM can be examined to detect the condition of anterior chamber angle, iris, ciliary and anterior choroid, which is significant for comprehensively understanding the preoperative condition of patients, estimating the difficulty of the operation, and guiding operation and the postoperative follow-up.

OBJECTIVE:To observe clinical efficacy and safety of tiotropium bromide combined with budesonide formoterol in the treatment of severe bronchial asthma in adults. METHODS:A total of 110 adult patients with severe bronchial asthma were selected from our hospital during Mar. 2013-Mar. 2016 were divided into control group and observation group according to random number table,with 55 cases in each group. Control group was given Budesonide formoterol powder for inhalation,2 inhalations each time,bid;observation group was additionally given Tiotropium bromide powder for inhalation 18 μg,qd,on the basis of con-trol group. Both groups were treated for 6 months. Clinical efficacies as well as ACT scores,respiration function indexes and the times of acute attack of asthma before and after treatment,the occurrence of ADR were compared between 2 groups. RESULTS:The efficiency rate and total response rate of observation group were 54.55% and 96.36%,which were significantly higher than 32.73%,78.18% in control group,with statistical significance(P<0.05). Before treatment,there was no statistical significance in ACT scores,respiration function indexes or the times of acute attack of asthma between 2 groups(P>0.05). After treatment,ACT scores of 2 groups were significantly higher than before treatment;FEV1,FEV1/FVC and PEF were significantly greater than be-fore treatment,PEFR was significantly lower than before treatment;and the indexes in observation group was significantly better than control group,with statistical significance(P<0.05). 1,3,6 months after treatment,the times of acute attack of asthma in 2 groups were significantly less than before treatment,and that in observation group was significantly less than control group,with statistical significance(P<0.05). The incidence of ADR in observation group was 20.00%,and there was no statistical signifi-cance compared to 14.55% of control group(P>0.05). CONCLUSIONS:Tiotropium bromide combined with budesonide formoter-ol in the treatment of severe bronchial asthma in adults can effectively relieve the severity of disease,improve respiration function, reduce the times of acute attack of asthma,and have good therapeutic efficacy and safety.

OBJECTIVE To summarize the clinical features, diagnosis, treatment and prognosis of laryngeal rhabdomyosarcoma.METHODS The clinical data of 5 cases of adult laryngeal rhabdomyosarcoma treated in Beijing Tongren Hospital between 2003 and 2015 were analyzed retrospectively.RESULTS All the 5 cases firstly presented with hoarseness. 1 case was treated by combined therapy (surgery followed by radiotherapy and chemotherapy). 2 patients received surgical treatment combined with chemotherapy. 1 patient received surgical treatment only. Another patient received chemotherapy only. Pathological type: 4 patients were embryonal rhabdomyosarcoma, 1 patient was pleomorphic rhabdomyosarcoma. In the follow-up of a period from 11 months to 8 years, 2 cases were alive without tumor, 3 patients were dead.CONCLUSION Adult laryngeal rhabdomyosarcoma is rare. Surgical resection combined with chemotherapy is the main treatment method, and the prognosis is related to the pathological type and tumor stage.

This article was aimed to study the intestinal absorption about main active ingredients of pectolinarin and pectolinarigenin in Carboned Cirsium japonicum DC. The absorption rate and absorption rate constant were taken as indicators. The intestinal absorption of pectolinarin and pectolinarigenin were compared by everted rat intestinal sac method among different parts of the small intestine. The results showed that the absorption rate constant of pectoli-narin among duodenum, jejunum, ileum and colon parts were 0.505 1 ± 0.192 7, 0.936 0 ± 0.187 2, 0.732 0 ±0.133 5, 0.251 3 ± 0.027 6 (μg·h-1·cm-2). The absorption rate constant of pectolinarigenin among the duodenum, je-junum, ileum and colon were 0.059 1 ±0.008 3, 0.093 3 ±0.029 2, 0.112 3 ± 0.035 6, 0.029 4 ± 0.009 1 (μg·h-1·cm-2). It was concluded that the absorption of both ingredients increased over time. The absorption of both ingredi-ents in the jejunum and ileum was higher than other parts of the small intestine. The absorption rate of pectolinarin in the entire small intestine was much higher than the absorption rate of pectolinarigenin.

Objective To detect K-ras mutations in plasma by a nano capture probe system , and to explore the diagnostic and prognostic value of this method for patients with pancreatic cancer .Methods The clinical data of 62 patients with pancreatic cancer , 38 patients with benign pancreatic diseases and 31 healthy controls admitted in the Second Affiliated Hospital of Jiaxing Medical College from June 2013 to June 2015 were collected.The diagnosis of all the patients were confirmed by pathology .The DNA were extracted from all plasma samples and were detected for the codon 12 and 13 mutation of K-ras gene by nano capture probe and conventional PCR plus direct sequencing .The correlation of K-ras gene mutation with certain clinical data and the diagnostic and prognostic value in pancreatic cancer were analyzed .Results The K-ras mutation were detected by nano capture probe in 27 pancreatic cancer patients , and the mutation rate was 43.5%(27/62), including 25 cases with codon 12 mutation and 2 cases with codon 13 mutation .The K-ras mutation rate in patients with benign pancreatic diseases was 7.9%(3/38), which were all in codon 12.K-ras mutation was detected in only 17 pancreatic cancer patients by conventional PCR plus direct sequencing , and the mutation rate was 27.4%(17/62), The K-ras mutation rate of benign pancreatic diseases was 5.3%(2/38).The mutation rate detected by nano capture probe was higher than that by conventional PCR , and the difference was statistically significant (P=0.006).K-ras mutation in the plasma of patients with pancreatic cancer was related to TMN stage and liver metastasis , but there was no correlation of the factors such as sex , age, clinical symptoms, tumor size, serum CA19-9 and CEA levels with K-ras mutation.The sensitivity of K-ras gene mutation for diagnosing pancreatic cancer was 43.5%, the specificity was 92.1%, the positive predictive value was 90%, the negative predictive value was 50%, Youden index was 0.356.The 1-year survival rate of patients with K-ras mutation was 44.4%, which was lower than that (71.4%) of patients with wild-type K-ras, and the difference was statistically significant (P<0.05).Conclusions The nano capture probe system could certainly detect K-ras mutation in a small quantity of plasma DNA , and its diagnosis sensitivity for pancreatic cancer is low , but the specificity is relatively high .K-ras mutation in plasma is closely related to the TMN stage and prognosis of pancreatic cancer .

Objective To explore the efficacy of endovascular treatment for closed articular artery injuries.Methods The clinical data of 13 patients from Jan 2010 to Dec 2014 treated for closed articular artery injuries were analyzed retrospectively.The location,severity and extent of arterial injury were confirmed by intraoperative arteriography.The diameter and length of the injured arteries were measured.The guidewire was sent to the lesion site and working wire pathway was established.When the guidewire was difficult to pass through the lesion site,femoral and posterior tibial or radial artery may be used to establish working wire pathway.The stent or stent-graft was implanted through the contralateral femoral artery or distal end of ipsilateral artery.Results Intraoperative angiography confirmed intimal injury (n =2),partial transection (n =5),complete transection (n =5) and arteriovenous fistula (n =1).Eighteen stents or stent-grafts were implanted.Treatment was successful in all patients without peiropeartive death and procedure-related complications.All were followed up for 15 to 48 months and the mean follow-up was (30 ± 11) months.Three patients with stent lumen stenosis less than 50％ as showed by angiography.There was no stent fracture,displacement,or deformation.Conclusions Endovascular treatment for closed articular artery injuries is of less invasion,shorter operative time and quick postoperative recovery.

OBJECTIVE To study the incidence,pathogenesis,diagnosis and treatment of laryngeal cyst after partial laryngectomy.METHODS The clinical data of 228 cases of partial laryngectomy from January 2003 to June 2009 were retrospectively analyzed,and related literature was reviewed.RESULTS Two cases were found to have laryngeal cysts after partial laryngectomy during the post-operative follow-up.One occurred after 20 months,and the other occurred after 19 months.The cyst located on the tongue surface of the epiglottic was removed by CO2 laser under suspended laryngoscope,while the one located at the subglottic area was removed via cervical approach.So far,a total of 9 cases were reported.CONCLUSION Laryngeal cyst after partial laryngectomy is uncommon.That may be the mucosa planted during the operation.It could be misdiagnosed as recurrent laryngeal carcinoma.CT or MRI is helpful for diagnosis.Operation with CO2 laser under suspended laryngoscope or via cervical approach may be chosen.